I grant permission to use my Pet’s Photograph for use in newspapers, Facebook and/or our website.

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Veterinary Information

Primary Clinic

Veterinarian’s Name

Phone

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Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Please Select

Please Select

United States

Afghanistan

Albania

Algeria

American Samoa

Andorra

Angola

Anguilla

Antigua and Barbuda

Argentina

Armenia

Aruba

Australia

Austria

Azerbaijan

The Bahamas

Bahrain

Bangladesh

Barbados

Belarus

Belgium

Belize

Benin

Bermuda

Bhutan

Bolivia

Bosnia and Herzegovina

Botswana

Brazil

Brunei

Bulgaria

Burkina Faso

Burundi

Cambodia

Cameroon

Canada

Cape Verde

Cayman Islands

Central African Republic

Chad

Chile

China

Christmas Island

Cocos (Keeling) Islands

Colombia

Comoros

Congo

Cook Islands

Costa Rica

Cote d'Ivoire

Croatia

Cuba

Cyprus

Czech Republic

Democratic Republic of the Congo

Denmark

Djibouti

Dominica

Dominican Republic

Ecuador

Egypt

El Salvador

Equatorial Guinea

Eritrea

Estonia

Ethiopia

Falkland Islands

Faroe Islands

Fiji

Finland

France

French Polynesia

Gabon

The Gambia

Georgia

Germany

Ghana

Gibraltar

Greece

Greenland

Grenada

Guadeloupe

Guam

Guatemala

Guernsey

Guinea

Guinea-Bissau

Guyana

Haiti

Honduras

Hong Kong

Hungary

Iceland

India

Indonesia

Iran

Iraq

Ireland

Israel

Italy

Jamaica

Japan

Jersey

Jordan

Kazakhstan

Kenya

Kiribati

North Korea

South Korea

Kosovo

Kuwait

Kyrgyzstan

Laos

Latvia

Lebanon

Lesotho

Liberia

Libya

Liechtenstein

Lithuania

Luxembourg

Macau

Macedonia

Madagascar

Malawi

Malaysia

Maldives

Mali

Malta

Marshall Islands

Martinique

Mauritania

Mauritius

Mayotte

Mexico

Micronesia

Moldova

Monaco

Mongolia

Montenegro

Montserrat

Morocco

Mozambique

Myanmar

Nagorno-Karabakh

Namibia

Nauru

Nepal

Netherlands

Netherlands Antilles

New Caledonia

New Zealand

Nicaragua

Niger

Nigeria

Niue

Norfolk Island

Turkish Republic of Northern Cyprus

Northern Mariana

Norway

Oman

Pakistan

Palau

Palestine

Panama

Papua New Guinea

Paraguay

Peru

Philippines

Pitcairn Islands

Poland

Portugal

Puerto Rico

Qatar

Republic of the Congo

Romania

Russia

Rwanda

Saint Barthelemy

Saint Helena

Saint Kitts and Nevis

Saint Lucia

Saint Martin

Saint Pierre and Miquelon

Saint Vincent and the Grenadines

Samoa

San Marino

Sao Tome and Principe

Saudi Arabia

Senegal

Serbia

Seychelles

Sierra Leone

Singapore

Slovakia

Slovenia

Solomon Islands

Somalia

Somaliland

South Africa

South Ossetia

South Sudan

Spain

Sri Lanka

Sudan

Suriname

Svalbard

eSwatini

Sweden

Switzerland

Syria

Taiwan

Tajikistan

Tanzania

Thailand

Timor-Leste

Togo

Tokelau

Tonga

Transnistria Pridnestrovie

Trinidad and Tobago

Tristan da Cunha

Tunisia

Turkey

Turkmenistan

Turks and Caicos Islands

Tuvalu

Uganda

Ukraine

United Arab Emirates

United Kingdom

Uruguay

Uzbekistan

Vanuatu

Vatican City

Venezuela

Vietnam

British Virgin Islands

Isle of Man

US Virgin Islands

Wallis and Futuna

Western Sahara

Yemen

Zambia

Zimbabwe

Other

Country

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In order to ensure your pet’s health and the health of the other pets, you will be asked to provide proof of the following:DA2PP (distemper/parvo), Rabies, annual Bordetella, Canine Influenza (H3N8 / H3N2), Leptospirosis, negative 6 months fecal sample, annual negative heartworm test, and veterinary approved monthly heartworm and flea prevention.

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My Pet’s Information and Profile(If more than one pet is enrolling, please fill out another form.)

Dog’s Name

Breed

Sex

Date of Birth

NEUTERED

SPAYED

NEUTERED/SPAYED

If not, when?

Does he/she have any Hearing or Physical Handicaps?

If yes, please explain

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My Pet Needs Medications

Yes

No

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Type

Reason

Frequency

Amount

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Yes

No

Does your Dog have any Food Allergies or Special Needs?

Yes

No

Does your Dog have any Past or Current Injuries or Disabilities?

If yes, explain.

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Yes

No

My Dog Is House Trained

Do you use a Command?

BIG DOGS

LITTLE DOGS

OLDER DOGS

YOUNG DOGS

PUPPIES

My Dog Plays Best with

SHY

MELLOW

EXCITABLE

ACTIVE

COUCH

POTATO

My Dog is

My Dog’s Favorite Activities

Obedience

Training

Commands

My Dog Is Trying to Learn the following

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My Dog Is Easily Scared by

BITTEN

GROWLED

SNARLED

BARED

TEETH

SHOWN

THREATENING

BEHAVIOR

My Dog Has

Explain Situation of any or all selected above

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Reasons for Using Daycare

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Additional Information I Would Like You to Know About My Dog(s)

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Daycare Consent Agreement

As a Condition of using our Services for your Pets, the following

Daycare Consent Agreement must be Initialed and Signed.

By choosing to utilize the services, participate in daycare activities, boarding and/or grooming my pet(s) at Paws At Play Resort & Daycare, I agree to the following: (Please initial each statement.)

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I agree to pay the rates that are in effect at the time my pet is at Paws At Play Resort & Daycare. I am aware that extra chargesmay be incurred and I agree to pay them at the time of pick-up. Examples include, but are not limited to: daycare, grooming,activities, boarding, medical care and late fees.

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Paws At Play Resort & Daycare is a cage-free facility. If my dog participates in daycare, I understand that an interactive play settingis not without some risk of injury, that despite all the dogs appearing healthy and being handled with the greatest amount of care andforesight, dogs are not always predictable, and the unexpected may occur. I recognize that the benefits of an interactive playgroup arevaluable to my dog, and accept the potential risks. I further agree to pay veterinary/medical expenses incurred as a result of injury to orcaused by my dog.

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If my pet appears to be ill, Paws At Play Resort & Daycare will first contact me to discuss concerns. If I am unavailable and theconcerns are determined to be serious or life threatening, then I authorize Paws At Play Resort & Daycare to engage the services of theveterinarian-on-call, North Royalton Animal Hospital, at my expense, and all decisions will be made in the best interest of my pet’s health. Iagree to pay all veterinary charges incurred by my pet while in the care of Paws At Play Resort & Daycare. I will not hold Paws At PlayResort & Daycare liable for failure to seek veterinary attention or for decisions made under this contract. All reasonable attempts will bemade to contact you immediately in the event of an emergency.

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I understand that Paws At Play Resort & Daycare will exercise all due diligence and care in the guardianship of my pet. I herebywaive and release, Paws At Play Resort & Daycare, its employees, owners and agents from any and all liability of any nature, for injuryor damage, including that which may result from the action of any dog including my own. I expressly assume the risk of such damageor injury while my dog participates in or attends any function of Paws At Play Resort & Daycare while on the grounds or thesurrounding area thereto

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I understand that I am required to provide Paws At Play Resort & Daycare documented records and to keep the vaccination upto-date for the duration of my dog participation at Paws At Play Resort & Daycare. These vaccines include DA2PP, Rabies, Bordetella, CanineInfluenza (H3N8 & H3N2), and Lepto. Must have a negative fecal sample every 6 months annual negative heartworm test, and be on veterinaryapproved flea and heartworm prevention. Failing to meet these requirements will result in immediate dismissal from the facility.

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All dogs must be at least 4 months of age or older. All dogs over the age of 7 months must be spayed or neutered. Puppies and rescuedogs must be in the home for 1 month prior to coming to daycare.

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All dogs must be in good health. Owners will certify that their dog(s) are in good health and have not been ill with a communicable conditionin the last 14 days. Upon admission, all dogs must be free of any condition that could potentially jeopardize other guests, including but not limitedto upper respiratory infections, intestinal parasites and fleas. Dogs that have been ill with a communicable condition in the last 14 days will requireveterinarian certification of health to be permitted to return. Owner will accept full financial responsibility for any and all expenses involved by ourveterinarian-on-call at North Royalton Animal Hospital, when necessary.

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Owners will need to certify that their dog(s) have not harmed or shown aggression or threatening behavior towards any person or otherdog(s). Paws At Play Resort & Daycare reserve the right to refuse admittance to any dog that does not meet the requirements or dismiss any petthat exhibits threatening behavior.

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Personal items such as toys are not permitted at daycare

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If a pet that is presented for daycare and is found to have fleas and/or ticks, it will be treated at the owner’s expense by our veterinarian-oncall at North Royalton Animal Hospital.

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Dogs are not fed during daycare hours to prevent resource guarding and fighting. If a pet needs to be fed for medical reasons, then thismust be discussed and agreed upon in advance of attendance at daycare.

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The center closes at 6:30 PM. Unless special arrangements have been made, there is a $1.00 per minute charge for any dog left after 6:30PM.

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I expressively wave and relinquish any and all claims against Paws At Play Resort & Daycare, its employees and representatives, exceptthose arising from negligence on the part of Paws At Play Resort & Daycare.

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I have disclosed to Paws At Play Resort & Daycare all known dangers associated with my dog(s).

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I expressively understand and agree that Paws At Play Resort & Daycare shall not be held responsible for any damage to my property, orthat of others, caused by my dog(s) during the period in which they are in its care.

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On behalf of myself and any and all other owners of this pet, I have read and agree to the terms of this contract. I warrant that I have the authority to represent any and all other owners of this pet in signing this contract. I have initialed each statement above to acknowledge my understanding and acceptance.